In his letter, Dr Melton speculates about the possible reasons for our observation on the declining rates of hip fracture in Finland since the late 1990s.(1) As we clearly pointed out in our Discussion, the exact reasons for this secular change are unknown, although many potential explanations can be given. A cohort effect toward healthier elderly population and improved functional ability among elderly Finns may indeed refer to the “compression of morbidity” in their lifespan. These phenomena are not simple and straightforward, however. In our country, evidence is strong for improved functionality among elderly women and men to the age group of 80–84,(2, 3) whereas among the oldest old (persons ≥85 yr of age), the functional ability has not improved during the recent two decades.(4) The Canadian investigators, without any direct evidence for cause-effect relationship, attributed a decline in hip fracture incidence in Ontario in 1992–2000 to increased use of bone densitometry and antiresorptive therapy.(5) In their related Editorial, Melton et al.(6) were, however, rather critical about such a straightforward interpretation. Among other criticism, Melton et al. pointed out that similarly declining hip fracture incidence rates have been seen in Rochester women since 1950 and in Rochester men since 1980, a similar climatologic region, the decline thus occurring decades before osteoporosis screenings and therapies became available. In Finland, use of bone-specific drugs was so uncommon in the 1990s that its role must have been minor in explaining the decreased hip fracture incidence since 1997. This especially concerns our elderly men. As discussed in our paper in detail,(1) many other factors may have contributed to the declined hip fracture risk in Finland. Almost 100% of elderly Finns are white, so racial differences cannot be examined in this country. Concerning sex, the decline has occurred in both women and men, the phenomenon being especially clear in women.(1) Since 1997, the age-specific incidence rates have declined in both sexes, but interestingly, only after the age of 65. In women, the relative decline has been about the same in each age group (65–74, 75–84, and 85+), whereas in men, the strongest effect has been seen in the youngest elderly group. No clear difference in decline has been observed between cervical and trochanteric fractures. Our database does not allow geographic subregional analysis, but a fresh regional report from Oulu, northern Finland, between 1980 and 2005 confirmed our nationwide observation on declining rate of hip fracture.(7) Tobacco use is rather uncommon in Finnish older adults. Among persons ≥65 yr of age, 15% of men and 5% of women smoked daily in 1985, and these percentages have not changed much since then.(8) Thus, smoking and its changes can not explain the decreased hip fracture incidence in Finland. On the contrary, increased average body weight is a strong candidate to partly explain the decrease.(1) Concerning many other potential contributors, such as unexpected beneficial effects of medications for other conditions or secular reductions in various comorbid conditions, evidence is more limited. Because falling and compromised bone strength alone, or more frequently in combination, are the two independent and immediate risk factors of elderly hip fractures (through which all the other, more distant risk factors operate), studies on any potential contributor should also include falls and bone data to provide robust clues for fracture prevention.(9, 10)